What is the DOC?
Obsessive-compulsive (DOC) disorder is a complex and often debilitating clinical condition, generally characterized by the presence of obsessions and compulsions.
The former have to do with intrusive thoughts, mental images or impulses involuntary, recurring and unwanted. Obsessions can generate anxiety or other unpleasant emotions such as, for example, disgust, guilt, etc. They lead those who suffer from DOC to implement compulsions to relieve these unpleasant sensations.
The compulsions Therefore, they are behaviors aimed at reducing the sense of discomfort, anxiety or other unpleasant emotional experiences caused by obsessions. They can manifest themselves as physical actions clearly visible from the outside (over) or as actions performed within one’s mind (cover).
Obsessions and compulsions significantly interfere with daily life, causing significant personal and social problems in the subject.
Shame and doc: what relationship?
In the context of the doc, shame is particularly relevant in the category of obsessive-compulsive disorder characterized by intrusive thoughts, doubts, mental images or impulses whose content is evaluated by the person as dangerous, unworthy or morally wrong (Unacceptable thoughts/impulses).
The obsessive thoughts that affair this subtype are evaluated by the person as unacceptable as their content is in conflict with the representation it has of themselves: thus, unacceptable thoughts can lead to experiences of shame, self -pier and self -criticism.
For example, a person with DOC could feel shame for aggressive thoughts or unwanted sexual impulses.
Clinical examples
Giuseppe, a 37 -year -old man, who suffers from aggressive thoughts/fantasies/impulses towards people dearly feel an intense shame and anxiety and consequently exercises a marked avoidance of social contact.
Agnese, a 26 -year -old young woman, is tormented, however, by Thoughts/Fantasies/intrusive sexual impulses towards sexual “objects” deemed inappropriate that cause them a profound sense of shame.
However, shame is an emotion frequently experienced in others too DOC clinical subtypes. It is often due to rumination and self -criticism related to the implementation of compulsive rituals.
The people who suffer from Doc are judged, in fact, in a very hard and critical way when they resort to dysfunctional strategies for managing emotional discomfort With consequent unpleasant emotions, including shame, which increase the probability of resorting to further avoidance strategies, thus maintaining the disorder.
Empirical research
Empirical research has highlighted that shame has a significant role in maintaining the doc. In particular, a study published in the British Journal of Clinical Psychology in 2022 explored the correlation between shame and the doc, offering new ideas for mental health professionals.
The authors carried out a systematic review of the scientific literature in this context by examining twenty studies, of which eighteen have been included in a meta-analysis. The latter made it possible to combine the most data studies relating to obsessive-compulsive disorder and shame.
The results revealed a positive, moderate and significant correlation between the total scores of DOC and shame. In addition, weak but positive relationships have emerged between the shame and specific symptomatological dimensions of the DOC, such as unacceptable thoughts.
Overall, the results to which the authors have received indicate that there is a significant probability that individuals who experience an obsessive-compulsive symptomatology experience also experiences of shame. Shame therefore plays an relevant role in the DOC, influencing both gravity and the subjective experience of symptoms.
Implications for therapists
The aforementioned results underline the importance of face shame in the treatment of the DOC. For therapists it is essential to consider shame during evaluation and treatment and conduct targeted interventions in order to significantly improve the effectiveness of the intervention.
It is fundamental, for this purpose, validate the need for security of ours patients with obsessive-compulsive disorder And their need to resort to uncomfortable management strategies: they frequently judge themselves in a very harsh and critical way. It is essential to communicate to them that what they do is not “crazy”, as they themselves think or how they are often postponed to them by the closest people, but it is something that has the function of removing an intense and extreme unwilling discomfort and that is the only way they have found to do it.
Need normalize The behaviors pointing out that yes, they are absolutely disabled strategies and certainly must be abandoned, but these strategies were born with the purpose (in itself healthy) of regulate the unpleasant emotional activation.
Increase awareness of suffering from a disorder, through the psychoeducationIt also allows the patient with DOC to move from a negative self-evaluation (for example, “you are horrible”) to an evaluation of the type: “You are a person who suffers from obsessive-compulsive disorder” and this leads him to reduce self-criticism towards him.
Supplementary interventions
Therapists could consider, in addition, the integration of interventions such as the Compassion Focused Therapy (Gilbert, 2010) To exercise the patient’s self-compliance and to enhance the work on the inductic broken process in which it is hired, with consequent emotions of shame, and to change the way of relating to itself by promoting greater acceptance of oneself.
In this regard, for example, you can ask the patient, to write a compassionate letter to himself to distance himself from his self -critical inner dialogue. Furthermore, in session the practice of the compassionate self or creating a compassionate self -image that unfolds to the patient acceptance and serenity and that can recall to memory whenever every time he realizes that he is particularly critical towards him can also be conducted in session.
After building his compassionate self, he can work with the patient on episodes in which he was very critical of him asking him to try to face them through the perspective of his compassionate self.
To work on the emotion of shame, the understanding of this emotion: It should be noted to the patient that it is linked to the threat system and that, when it is activated for prolonged periods of time and at high levels of intensity, it can become a block for our calming and affiliation system and hinder our connection to others.
You can use the compassionate self built in meditation, to ensure that the patient is related to the part of himself who feels shame so that he can use the compassionate perspective, over time, to interact with the self -criticism based on shame. Exercising compassion is a very effective way to work with this emotional experience.
Conclusions
The understanding of the role of shame in the DOC opens new paths for research and clinical practice.
Although further research is needed in this area, shame plays a significant role in maintaining and inteasing the symptoms of obsessive-compulsive disorder. Deepening how it interacts with symptoms can lead to developing more effective and personalized therapeutic approaches.
Understand and treat shame through specific interventions It represents a crucial step towards a more omnic -comprehensive therapeutic process in order to improve therapeutic efficacy and reach significant improvements in the quality of life of our patients.
Bibliographic references
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: American Psychiatric Press.
- Beck, JS (2013). Cognitive-behavioral therapy. Rome: astrolabe.
- Gilbert, P. (2012). Therapy focused on compassion. Distinctive features. Milan: FrancoAngeli.
- Laving, M., Foroni, F., Ferrari, M, Turner, C., & Yap, K. (2022). The Association Bethaeen Ocd and Shame: A Systematic Review and Meta-Aalysis. British Journal of Clinical Psychology, 62, 28-52.
- Melli, G. (2018). Winning obsessions: understanding and facing obsessive-compulsive disorder. Trento: Erickson.
- Melli., G., & Carraresi., C. (2023). Cognitive-behavioral therapy of obsessive-compulsive disorder. Complete manual for assessment and treatment. Trento: Erickson.
